Study links self-monitoring with fewer medications

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CHICAGO — Letting patients measure their own blood pressure at home could help detect “white coat hypertension” — a high reading that occurs only in the doctor’s office — and enable many people to get off medication, a study found.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

The study, published in Wednesday’s Journal of the American Medical Association, was conducted in Ireland and Belgium and involved 400 men and women with high blood pressure.

They were randomly assigned to measure their own blood pressure at home several times a day or to have measurements taken routinely in a doctor’s office for up to a year.

Doctors who were not told which patients had monitored themselves and which ones had undergone office monitoring evaluated the readings and adjusted people’s blood pressure medication accordingly.

About 25 percent of the self-monitoring patients were allowed to stop taking hypertension drugs because their diastolic pressure — the bottom reading — was below 80, compared with about 11 percent of the office group.

U.S. guidelines classify normal blood pressure as below 120 over 80; high blood pressure is 140 over 90 or higher.

In the study, more office patients than self-monitors were advised to start taking more than one blood pressure drug, 45 percent versus about 39 percent.

At the study’s end, the self-monitoring group had higher average blood pressure than the office group: Their systolic reading — the top number — was about seven points higher, their diastolic reading three points higher.

The self-monitors thus might be more likely to develop a stroke or heart disease, the researchers said.

Because of that, the study’s lead author, Dr. Jan Staessen of the University of Leuven in Leuven, Belgium, said doctors should probably set a lower blood-pressure cutoff point for self-monitoring patients when deciding whether to reduce or eliminate their medication.

The American Heart Association is preparing new blood pressure guidelines that will include a section on self-monitoring.

Association spokesman Dr. Daniel Jones said the study results suggest that self-monitoring might be useful in some settings but not as a replacement for office measuring.

The pharmaceutical company AstraZeneca funded the study and supplied some of the blood-pressure medication.